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Observational Study
. 2024 Nov-Dec:68:131-144.
doi: 10.1016/j.hrtlng.2024.06.015. Epub 2024 Jul 4.

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Denise Battaglini  1 , Thu-Lan Kelly  2 , Matthew Griffee  3 , Jonathon Fanning  4 , Lavienraj Premraj  5 , Glenn Whitman  6 , Diego Bastos Porto  7 , Rakesh Arora  8 , David Thomson  9 , Paolo Pelosi  10 , Nicole M White  11 , Gianluigi Li Bassi  12 , Jacky Suen  4 , John F Fraser  13 , Chiara Robba  10 , Sung-Min Cho  6 ; COVID-19 Critical Care Consortium Investigators
Collaborators, Affiliations
Observational Study

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Denise Battaglini et al. Heart Lung. 2024 Nov-Dec.

Abstract

Purpose: We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality.

Methods: International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders.

Results: 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4-44.9) LMICs and 17.6 (95 %CI = 15.8-19.7) HICs; ischemic 9.47 (95 %CI = 6.57-13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73-10.9) LMICs, and 2.52 (95 %CI = 2.00-3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75-17.3) LMICs, 8.99 (95 %CI = 7.70-10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31-2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29-2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19-1.72), p < 0.001)].

Conclusions: Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority.

Trial registration: ACTRN12620000421932 registered on 30/03/2020.

Keywords: COVID-19; Disability; Income countries; Neurological complications; Stroke.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, John F Fraser is recipient of The Bill & Melinda Gates Foundation, Grant number INV-034765; Queensland Health; The Prince Charles Hospital Foundation; The Wesley Medical Research; Fisher & Paykel Healthcare; The University of Queensland; The Health Research Board of Ireland. Gianluigi Li Bassi is a recipient of the BITRECS fellowship; the “BITRECS” project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 754550 and from the “La Caixa” Foundation (ID 100010434), under the agreement LCF/PR/GN18/50310006. Jacky Y Suen is funded by the Advance Queensland fellowship program, Queensland Government, Australia. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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